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6023PSY ProPsych > Week 3 - Assessment, MSE, Diagnosis/DSM > Flashcards

Week 3 - Assessment, MSE, Diagnosis/DSM Flashcards

1
Q

How do Shum, O’gorman & Myers (2006) define a psychological test?

A

“A psychological test is an objective procedure for sampling and quantifying human behaviour to make inference about a particular psychological construct using standardised stimuli and methods of administration and scoring”

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2
Q

How do McIntire & Miller, (2007)define a psych test?

A

A psychological test is something that requires you to perform a behavior to measure some personal attribute, trait, or characteristic or to predict an outcome

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3
Q

Types of psychological tests?

A

LOTS of different types –

IQ tests,

personality tests,

interest and vocational inventories,

tertiary entrance exams,

classroom tests,

structured interviews,

self-report measures,

even self-scored tests you find in Cosmo! (McIntire & Miller, 2007)

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4
Q

Why do we need psych tests?

A

For decision making

  • Classification
  • Dx and tx planning
  • Program evaluation

-Tests are often better and more accurate than clinical judgment in informing the decision making process

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5
Q

Psychological Tests vs Assessment

A

Often these terms are used interchangeably, however;

Assessment is more comprehensive

“Assessment can be defined as appraising or estimating the magnitude of one or more attributes of a person. The assessment of human characteristics involves observations, interviews, checklists, inventories, and other psychological tests.”

Tests are only one source of information used in the assessment process

Assessors must combine and compare data from different sources

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6
Q

Eating Disorders Inventory-III
(EDI-III)
Garner (2004)

A
  • 91 items
  • one of the most widely used self-report measures of eating disorder related traits
  • mostly used for females aged 13 years+
  • 3 eating disorder specific scales
  • 9 general psych scales
  • 6 composite scales
  • -Eating Disorder Risk
  • -Ineffectiveness
  • -Interpersonal Problems
  • -Affective Problems
  • -Overcontrol
  • -General Psychological Maladjustment
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7
Q

EDI-III

Eating Disorder Risk Subscale

A

Drive For Thinness

Bulimia

Body Dissatisfaction

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8
Q

EDI-III

Ineffectiveness Subscale

A

Low Self-esteem

Personal Alienation

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9
Q

EDI-III

Interpersonal Problems Subscale

A

Interpersonal Insecurity

Interpersonal Alienation

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10
Q

EDI-III

Affective Problems Subscale

A

Interoceptive Deficits

Emotional Dysregulation

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11
Q

EDI-III

Overcontrol Subscale

A

Perfectionism

Asceticism

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12
Q

EDI-III

General Psychological Maladjustment subscale

A 
Low self esteem
Personal alienation
Interpersonal insecurity
Interpersonal alienation
Interoceptive deficits
Emotional dysregulation
Perfectionism
Asceticism
Maturity fears
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13
Q

EDI-III

Scoring

A

uses a 0-4 scoring system

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14
Q

EDI-3 SC (symptom checklist)

A

Data on Frequency of symptoms

Weight, Weight hx, Menstrual Hx

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15
Q

EDI-3 RF (referral form)

A

Quick form that can be used to determine whether a referral is necessary (for schools, athletic institutions etc.)

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16
Q

Can you Diagnose with the EDI-III?

A

NO

however;

gives a lot of rich information pertaining to characteristic associated with eating disorders

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17
Q

Beck Depression Inventory - II
BDI-II
Beck, Steer & Brown (1996)

how many items/scoring

A

No questionnaire is diagnostic!!!! Just helps…

Scored from 0-3

Scoring – sum of all items:
0-13 - minimal depression
14-19 – mild depression
20-28 – moderate depression
29-63 – severe depression

Good psychometric properties

Beware the ill when using this measure!

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18
Q

Beck Anxiety Inventory
(Beck & Steer, 1990)

purpose/how many items/scoring

A

Constructed to measure symptoms of anxiety that are minimally shared with depression

21 Items scored from ‘not at all’ (0) to ‘severely’ (3)

Measures severity of anxiety in adults and adolescents

Severity:
0-7: minimal
8-15: mild
16-25: moderate
26-63: severe
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19
Q

Depression Anxiety Stress Scale
(DASS)
how many scales / items

A

3 scales: Depression, Anxiety & Stress

Each scale contains 14 items,

42 items total

4-point severity/frequency scales to rate the extent to which they have experienced each state over the past week

Scores for Depression, Anxiety and Stress are calculated by summing the scores for the relevant items

Also the DASS21 - 7 items per scale

Good psychometric properties

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20
Q

DASS

Depression Scale

A 
dysphoria
hopelessness
devaluation of life
self-deprecation
lack of interest/involvement
anhedonia
inertia
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21
Q

DASS

Anxiety Scale

A

autonomic arousal

skeletal muscle effects

situational anxiety

subjective experience of anxious affect

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22
Q

DASS

Stress Scale

A 
levels of chronic non-specific arousal
difficulty relaxing
nervous arousal
being easily upset/agitated
irritable/over-reactive and impatient
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23
Q

Achenbach System of Empirically Based Assessment

(ASEBA)

Achenbach, Thomas M. & Rescorla, Leslie A. (2001).

A

There are parent reports (CBCL),youth reports (YSR) and teacher reports (TRF) for comparison across informants

can either be self-administered or administered through an interview

the first section of this questionnaire consists of 20 competence items

the second section consists of 120 items on behavior or emotional problems during the past 6 months

Two versions : one for children ages 1 1/2 - 5 and another for ages 6 - 18.

Different report forms / norms for males and females

Good psychometric properties

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24
Q

ASEBA Child Behaviour Checklist (CBCL) (for parents)

how many items, scoring

A

The CBCL/6-18 has 118 items that describe specific behavioral and emotional problems, plus two open-ended items for reporting additional problems.

Parents rate their child for how true each item is now or within the past 6 months using the following scale:
0 = not true (as far as you know)
1 = somewhat or sometimes true
2 = very true or often true.
The CBCL/6-18 scoring profile provides raw scores, T scores, and percentiles for three competence scales (Activities, Social, and School), Total Competence, eight cross-informant syndromes, and Internalizing, Externalizing, and Total Problems.

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25
Q

ASEBA

The six DSM-Oriented scales are?

A

Affective Problems

Anxiety Problems

Somatic Problems

Attention Deficit/Hyperactivity Problems

Oppositional Defiant Problems

Conduct Problems

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26
Q

The Spence Child Anxiety Scale

(SCAS)

(purpose, what does it assess)

A

Developed to assess DSM-IV anxiety disorders

Child and parent versions; also a pre-school version

Assesses six domains of anxiety:

  1. generalized anxiety
  2. panic/agoraphobia
  3. social phobia
  4. separation anxiety
  5. obsessive compulsive disorder
  6. physical injury fears
27
Q

SCAS

items/scoring

A

Child version: 44 items – 38 address symptoms, 6 reflect response bias

Parent version: 38 items

Preschool version: 28 items

Pre-school teacher: 22 items

Takes around 10 minutes to complete

Rate on a 4-point scale :never (0), sometimes (1), often (2), and always (3), the frequency with which they experience each symptom

Good psychometric properties

28
Q

Mental Status Examination
(MSE)

What is it?

A

A template that assists a Clinical Psychologist in the collation and subsequent conceptual organization of clinical information about a client’s emotional and cognitive functioning

By systematically basing observations on verbal and non-verbal behavior, the aim is to increase the reliability of the data upon which subsequent diagnoses and case formulation are made

Following Daniel & Crider (2003) an MSE collates information about the client’s

(i) physical
(ii) emotional
(iii) cognitive state

29
Q

MSE

physical measures

A

Appearance
Behaviour
Motor Activity

30
Q

MSE

Emotional Measures

A

Attitude

Mood and Affect

31
Q

MSE

Cognitive Measures

A 
Orientation
Attention and Concentration
Memory
Speech and Language
Thought (Form and Content)
Insight and Judgement
Intelligence and Abstraction
32
Q

MSE

helps to? description typicall begins how?

A

Draw attention to the key features that describe the client and frame the presenting problem within a context of who the client is

Typically the description will begin with a statement about their age, gender, relationship status, referrer and presenting problem (i.e., the reason for presentation at the service on the particular occasion)

E.g., “Gill, a young looking 35-year old, single woman was referred by her medical practitioner who had suggested treatment for obesity that was contributing to hypertension.”

33
Q

MSE

Physical - Appearance

A

A concise summary of the client’s physical presentation is given to paint a clear mental portrait

dress, grooming, facial expression, posture, eye contact, as well as any relevant noteworthy aspects of appearance

34
Q

MSE

Physical - Behaviour

A

May make reference to:

  • level of consciousness extending from alert through, drowsy, a clouding of consciousness, stupor (lack of reaction to environmental stimuli) and delirium (bewildered, confused, restless, and disoriented), to coma (unconsciousness)
  • degree of arousal (e.g., hypervigilance to environmental cues and hyperarousal such as observed in anxious and manic states)
  • mannerisms (e.g., tics and compulsions).
35
Q

MSE

Physical - Motor Activity

A

Describe both the quality and the types of actions observed:

  • -reduction in the level of movement (psychomotor retardation)
  • -slowed movement (bradykinesia)
  • -decreased movement (hypokinesia)
  • -absence of movement (akinesia)
  • -increases in the overall level of movement (psychomotor agitation)
  • -tremor
36
Q

MSE

Emotional -Attitude

A

Identifiers may be open, friendly, cooperative, willing, and responsive on one hand or closed, guarded, hostile, suspicious, passive on the other

Describe attentiveness, responses to questions, expression, posture, eye contact, tone of voice

37
Q

MSE
Emotional:
Mood & Affect
What is mood vs what is affect

A

Affect (an external expression of an emotional state) is potentially observable

Mood (internal emotional experience that influences perception of the world and behavioural responses) requires clinician to depend on the client’s introspections

38
Q

MSE
Emotional:
Mood & Affect

(descriptors, stability, range, appropriateness)

A

Descriptors:

  • euthymic (normal non-depressed, reasonably positive mood),
  • euphoric,
  • dysphoric,
  • hostile,
  • apprehensive,
  • fearful,
  • anxious,
  • suspicious

Stability of mood can also be noted, with the alternation between extreme emotional states being referred to as emotional lability

Range, intensity, and variability of affect can be variously portrayed:

  • -restricted (i.e., low intensity or range of emotional expression)
  • -blunted (i.e., severe declines in range and intensity of emotional range and expression)
  • -flat (i.e., absence of emotional expression,)
  • -exaggerated (i.e., an overly strong emotional reaction)

Appropriateness (expression incongruent with verbal descriptions and behavior)

-General responsiveness of the client.

39
Q

MSE

Cognitive - Orientation

A

A person’s orientation refers to their awareness of time, place, and person

Orientation for TIME refers to a client’s ability to indicate the current day and date (with acceptance of an error of a couple of days)

Orientation for PLACE can be assessed by why they have presented. Behavior should also be consistent with that expected in the setting in which they have arrived

Orientation for PERSON refers to the ability to know who you are, which can be assessed by asking the client their name and about the names of family members or friends.

40
Q

MSE

Cognitive - Attention and Concentration

A

Working memory (Baddeley, 1986; 1990) is the term now used in psychology to refer to the constructs called attention and concentration

The aim is to describe the extent to which a client is able to focus their cognitive processes upon a given target and not be distracted by non-target stimuli

–Digit span (the ability to recall in forward or reverse order increasingly long series of numbers presented at a rate of one per second) is a common way to assess these working memory functions, and normal individuals will recall around 6-8 numbers in a digits forward and 5-6 in digits backwards

“Serial sevens” in which seven is sequentially subtracted from 100. Typically people will make only a couple of errors in 14 trials.

41
Q

MSE

Cognitive - Memory

A

A MSE will typically assess memory using the categories of short and long-term memory

Categories do not map neatly onto models of memory in recent cognitive psychology (Andrade, 2001)

Aim of the MSE is to provide a concise description of a person’s behavior and screen them in a manner that can guide further assessment.

Recent or short-term memory

  • -ask about a recent topical event or who the President or Prime Minister is
  • -listen to three words, repeat them, and then recall them some time later in the interview. Most people will usually report 2-3 words after a 20-minute interval

Visual short-term memory
–copy and then reproduce from memory complex geometrical figures (such as those in the Rey Complex Figure task?)

–Long-term memory can be assessed by asking about childhood events.

42
Q

MSE

Cognitive - Thought (FORM & Content)

A

Form (or process) of thought is evident in terms of the

  • (i) quantity and speed of thought production
  • (ii) the continuity of ideas: (circumstantiality or tangentiality) or may perseverate with the same idea, word, or phrase

They may show a loosening of associations (where the logical connections between thoughts are esoteric (intended for or likely to be understood by only a small number of people with a specialized knowledge or interest)or bizarre)

Flight of ideas (very rapid thinking)

Blocking (person’s speech is suddenly interrupted by silences); circumstantiality (focus of a conversation drifts, but often comes back to the point)

Tangentiality (oblique, digressive, or irrelevant replies to questions)

43
Q

MSE

Cognitive: Thought (Form & CONTENT)

A

Content of thought

-Delusions are profound disturbances in thought content in which the client continues to hold to a false belief despite objective contradictory evidence, despite other members of their culture not sharing the same belief

  • vary on dimensions of plausibility and systematization
  • -persecutory (others are deliberately trying to wrong, harm, or conspire against another)
  • -grandiose (an exaggerated sense of one’s own importance, power, or significance)
  • -somatic (physical sensations or medical problems)
  • -reference (belief that otherwise innocuous events or actions refer specifically to the individual)
  • -control, influence and passivity (belief that thoughts, feelings, impulses, and actions are controlled by an external agency or force)
  • -nihilistic (belief that self or part of self, others, or the world does not exist)
  • -jealous (unreasonable belief that a partner is unfaithful)
  • -religious (false belief that the person has a special link with God)

More frequent issues:

  • phobias (excessive and irrational fears)
  • obsessions (repetitive, and intrusive thoughts, images, or impulses)
  • preoccupations (e.g., with illness or symptoms).
44
Q

MSE

Cognitive - Perception

A

Hallucinations: perceptual disturbance in which people have an internally generated sensory experience, so that they hear, see (visual), feel (tactile), taste (gustatory), or smell (olfactory) something that is not present or detectible by others

The most frequent hallucinations are auditory and typically involve hearing voices, calling, commanding, commenting, insulting, or criticizing

Hallucinations can also occur when falling asleep (hypnogogic) or when awaking (hypnopompic).

Other perceptual disturbances include:

  • -external world is unreal, different, or unfamiliar (derealization)
  • -self is different or unreal in that the individual may feel unreal, that the body is distorted or being perceived from a distance (depersonalization)

Perceptions can also be dulled or heightened

45
Q

MSE

Cognitive: Insight & Judgement

A

Insight is a dimension that describes the extent to which clients are aware that they have a problem

  • -A strong lack of insight can be an important indicator of unwillingness to accept treatment
  • -Insight refers also to an awareness of the nature and extent of the problem, the effects of their problem on others, and how it is a departure from normal

Judgment: The ability to make sound decisions can be compromised for a number of reasons
–ascertain if poor decisions are the result of problems in the cognitive processes involved in the decision making process, motivational issues, or failures to execute a planned course of action.

46
Q

MSE

Cognitive: Speech & Language

A

Described in terms of:

  • Rate (e.g., slow, rapid)
  • Intonation (e.g., monotonous)
  • Spontaneity
  • Articulation
  • Volume
  • Quantity of information conveyed:
  • —–mutism (i.e., absence of speech)
  • —–poverty of speech (i.e., reduced spontaneous speech)
  • —-pressured speech (i.e., rapid speech that is hard to interrupt and understand)

-Language includes reading, writing, and comprehension.

  • Disturbances such as aphasia (impairment of language, affecting the production or comprehension of speech and the ability to read or write)
  • –Non-fluent (where speech is slow, faltering, or effortful) or fluent
  • –Fluent aphasia speech that is normal in terms of its form (rhythm, quantity, and intonation), but is a meaningless perhaps including novel words (i.e., neologisms).
47
Q

MSE

Cognitive: Intelligence & Abstraction

A

A general indication of intelligence is said to be gained from the amount of schooling a person has had (?!):

  • -failure to complete high school indicating below average
  • –completion of high school indicating average intelligence
  • —-college or university education indicating high intelligence

Abstraction is the ability to recognize and comprehend abstract relationships – to extract common characteristics from a group of objects (e.g., in what way are an apple/banana or music/sculpture alike?), interpretation (e.g., explaining a proverb such as a stitch in time saves nine).

48
Q

Versions of the MSE

MMSE, CCSE, HSCS, MSQ, SPMSQ

A

Mini Mental State Exam (Folstein, et al., 1975)

  • -11-items, measure orientation, registration, attention & calculation, recall, language, and praxis
  • -Scores ranges from 0-30 and lower scores indicate greater impairment
  • -less sensitive for cases with milder impairment
  • -scores influenced by educational level

Cognitive Capacity Screening Examination (CCSE; Jacobs, et al., 1977)
–30-item screener to detect diffuse organic disorders; more appropriate for cognitively intact individuals

High Sensitivity Cognitive Screen (HSCS; Faust & Fogel, 1989)
–15-item scale; valid and reliable indicator of cognitive impairment

Mental Status Questionnaire (MSQ; Kahn, et al., 1960)
–10-item scale that shares the same weaknesses as MMSE but omits some key domains of function (e.g., retention and registration)

Short Portable Mental Status Questionnaire (SPMSQ; Pfeiffer, 1975)
–10-item scale for community or institutional residents; reliable indicator of organicity.

49
Q

Formal MSE - note

A

Formal MSE – not necessarily appropriate for all clients in all settings

Depends on level of psychopathology

Depends on requirements of setting

50
Q

DIAGNOSIS

Purposes of Diagnosis

A

Communication – lets us talk about a particular group of issues

Research – we’ve talked about the good and bad of this before – we can look at ‘when we have an individual with these particular problems…we know x, y, and z about them – because it has been shown to be so’
It makes research easier

(NOT categorising people – we are classifying disorders that people have!)

Treatment – helps to guide treatment
If we know that this person has Depression – then we have some idea of what best practice is for that disorder and where to go with it

51
Q

DIAGNOSIS

issues with diagnosis

A

Stigma, labelling:

  • -Heterogeneity
  • -Public perceptions
  • -Important implications
  • -Self-fulfilling prophecy

Categorical approach

  • -Heterogeneity
  • -Dimensional?
52
Q

DIAGNOSIS

issues with diagnosis - stigma & labelling

A

People assume that all people with a particular ‘label’ are the same – but very heterogeneous – even within the category – have to have 7 of the 9 etc

Worst with the public – e.g., ‘schizpophrenic’ – thanks to movies and ACA – people seem to think that they’re all knife-wielding maniacs reading to kill you as look at you – completely untrue – a very SMALL subsample of that population

Another point – try not to used ‘shizophrenic’ – a person with schizphrenia – the person has a disorder, they are NOT their label

Once a label is given, it’s hard to get rid of

Self-fulfilling prophecy – I’m this, and therefore I’ll always be this, and really then they always will – behave in accordance with their label or use it as an excuse – can get in the way of treatment

53
Q

DSM 5

description of it

A

First major revision in 20 years

Has taken 6 years

Have tried to make it tie in better with ICD-10 (and the future ICD-11)

Trying to help psychiatry (and presumably psychology) ‘better resemble medicine’…

Emphasise development, gender and culture on the presentation of disorders

54
Q 
DSM 5
(introduced when? changes?)
A

Introduced 2013
–947 pages; ? Diagnoses

Change in number system which allows for ‘point upgrades’ (cynically, for more sales as it cost APA US$25 million to produce)

Many changes in diagnoses and their criteria & organisation of diagnoses

Removal of multi-axial system (explained later)

55
Q

DSM 5

Chapters/Clusters

A 
Neurodevelopmental Disorders
Schizophrenia Spectrum and Other Psychotic Disorders
Bipolar and Related Disorders
Depressive Disorders
Anxiety Disorders
Obsessive-Compulsive and Related Disorders
Trauma- and Stressor-Related Disorders
Dissociative Disorders
Somatic Symptom and Related Disorders
Feeding and Eating Disorders
Elimination Disorders

Sleep-Wake Disorders
Sexual Dysfunctions
Gender Dysphoria
Disruptive, Impulse-Control, and Conduct Disorders
Substance-Related and Addictive Disorders
Neurocognitive Disorders
Personality Disorders
Paraphilic Disorders
Other Mental Disorders
Medication-Induced Movement Disorders and Other Adverse Effects of Medication
Other Conditions That May Be a Focus of Clinical Attention

56
Q

DSM - 5

Definition of a Mental Disorder

A

A mental disorder is a syndrome characterized by Clinically Significant disturbance in an individual’s cognition, emotion regulation, or behavior that reflects a dysfunction in the psychological, biological, or developmental processes underlying mental functioning. Mental disorders are Usually Associated with significant distress or disability in social, occupational, or other important activities. An Expectable or Culturally Approved response to a common stressor or loss, such as the death of a loved one, is NOT a mental disorder. Socially deviant behavior (e.g., political, religious, or sexual) and conflicts that are primarily between the individual and society are not mental disorders Unless the deviance or conflict results from a dysfunction in the individual, as described above.’

57
Q

DSM

things to note

A

Medical model

Descriptive

Guidelines - not cookbook

Clinical judgement = important

Does not require knowledge of its aetiology

Need to be mindful of cultural issues

Need more than diagnosis to develop treatment plan

58
Q

DSM

Coding and Reporting

A

Codes – subtypes – specifiers

Subtypes are mutually exclusive

Specifiers are not mutually exclusive (e.g., PTSD - chronic with delayed onset)
—Under DSM-5 some disorders and subtypes share the same code (e.g., 309.81 = PTSD) to make sure it is consistent with ICD-10 (upon which the US and Aus government and insurance companies rely for billing and funding, of course)

59
Q

DSM

Subtypes, Specifiers & Severity

A

Subtype: “Specify whether”—only choose one;

Specifier: “Specify if”—pick as many as apply;

Severity: “Specify current severity”—choose the most accurate level of symptomology.

60
Q

DSM

Ordering Diagnoses

A

The first diagnosis is called the principal diagnosis. In an inpatient setting, this would be the most salient factor that resulted in the admission (APA, 2013). In an outpatient environment, this would be the reason for the visit or the main focus of treatment. The secondary and tertiary diagnoses should be listed in order of need for clinical attention.

61
Q

DSM-5
Diagnosis
(provisional / not otherwise specified)

A

Provisional diagnosis: think criteria will be met but as yet not enough information

Not otherwise specified:
Four situations:
–Conforms to diagnostic class but does not meet criteria of subtypes (atypical/mixed presentation)
–Conforms to symptom pattern not in DSM (clinically significant distress/impairment)
–Uncertainty about aetiology (medical?)
–Insufficient information available (emergency/contradictory information)

62
Q

DSM-5

Multi-Axial Diagnosis

A

Discontinued 5-Axis system
No more problems of “Axis 2” or GAF?

NOS replaced by “Other Specified” or “Unspecified”
“Another Medical Condition” instead of “General Medical Condition”

Axis 4 gone

  • -might use V (or Z in ICD 10) codes:
  • —These are designed for occasions when circumstances other than a disease or injury result in an encounter or are recorded by providers as problems or factors that influence care. These codes represent the reason why the psych – patient encounter exists. It may be more for financial coding reasons used by insurance companies and health departments, not a measure of psychosocial / environmental stressors!

Axis 5 gone

  • -might use WHODAS. (World Health Org Disability Assessment Schedule)
  • -List multiple diagnoses in order of attention or concern
63
Q

Process of Differntial Diagnosis

A

How to differentiate one disorder from others with similar presenting characteristics

A process of systematically considering & ruling out other possibilities

Appendix A – decision trees for differential diagnosis

Read Differential Diagnosis section for disorder – consider all possibilities

Especially consider – substance-related disorders, medical conditions, adjustment disorder, clinical significance, rule out factitious disorder/malingering

6023PSY ProPsych (9 decks)

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